Transcript Slide 1

Action on Elder Abuse
Where are we at with
Adult Safeguarding?
Key points from the Law
Commission:
• a duty on social services to investigate or cause an investigation
into adult protection cases; and a duty on Government to
prescribe the process for such investigations;
•
a new definition of people at risk of abuse and of harm in order
to ensure those in need receive adequate protection;
• a statutory basis for adult safeguarding boards which should as
a minimum comprise local social services, police and health;
• the legal requirement to establish serious case reviews; and an
enhanced duty to cooperate between relevant organisations.
Government response:
• Safeguarding Boards will be made statutory.
• A statement of principles for use by Local Authority Social
Services and housing, health, the police and other agencies for
both developing and assessing the effectiveness of their local
safeguarding arrangements.
• Principles: Empowerment, Protection, Prevention,
Proportionality, Partnership, and Accountability
• The outcomes for adult safeguarding, for both individuals and
agencies
Empowerment: the presumption of person-led decisions
and informed consent
Agency objective:
We give individuals relevant information about
recognising abuse and the choices available to them to
ensure their safety. We give them clear information
about how to report abuse and crime and any
necessary support in doing so. We consult them before
we take any action. Where someone lacks capacity to
make a decision, we always act in his or her best
interests.
Protection
Support and representation for those in greatest
need
Agency objective:
Our local complaints, reporting arrangements for abuse
and suspected criminal offences and risk assessments
work effectively. Our governance arrangements are
open and transparent and communicated to our
citizens.
Prevention
It is better to take action before harm occurs
Agency objective:
We can effectively identify and appropriately respond
to signs of abuse and suspected criminal offences. We
make staff aware, through provision of appropriate
training and guidance, of how to recognise signs and
take any appropriate action to prevent abuse occurring.
In all our work, we consider how to make communities
safer.
Proportionality Proportionate and least intrusive response
appropriate to the risk presented.
Agency objective:
We discuss with the individual and where appropriate
with partner agencies the proportionality of possible
responses to the risk of significant harm before we take
a decision. Our arrangements support the use of
professional judgement and the management of risk.
Partnership
Local solutions through services working with their
communities. Communities have a part to play in
preventing, detecting and reporting neglect and
abuse
Agency objective:
We have effective local information-sharing and multiagency partnership arrangements in place and staff
understand these. We foster a “one” team approach
that places the welfare of individuals above
organisational boundaries.
Accountability Accountability and transparency in delivering
safeguarding
Agency objective:
The roles of all agencies are clear, together with the
lines of accountability. Staff understand what is
expected of them and others. Agencies recognise their
responsibilities to each other, act upon them and
accept collective responsibility for safeguarding
arrangements.
Principles in context –
investigating crimes in
care home settings
KEY POINTS:
All investigations within a care home should be designated critical incidents
and be subject to a community impact assessment.
When investigating crimes within a residential care home setting, consider
whether it is feasible and appropriate to use officers dressed in casual wear in
order to avoid further anxiety or distress to other residents.
Agree with the care home owner/manager what information can be shared
with relatives, residents and staff that provides factual information about what
has occurred and what is happening.
Ensure that investigating officers are aware of both the potential
communication needs of witnesses and what sources of support are available
e.g. local advocacy providers, Independent Mental Capacity Advocates
(IMCA) etc.
KEY POINTS:
Investigating officers should be trained in the Mental Capacity Act (2005) and
be aware that capacity is both time and decision specific.
Recognising that the care home environment is the resident’s family home,
and that domestic abuse perpetrators are often serial abusers, will ensure
that DV strategies can be considered.
Neither the police nor any member of the safeguarding team can prevent an
employer from undertaking a disciplinary investigation, even where a criminal
investigation has begun. Nor can anyone instruct an employer to suspend, or
not suspend, an employee.
KEY POINTS:
If the investigation is complex and is likely to continue for a significant period
of time in excess of four weeks, it is probable that the employer will have to
proceed with the disciplinary process. In such circumstances it is important
that the police and employer consider carefully how to do this with least
impact upon the criminal investigation.
It is helpful if the senior investigating officer could provide timely updates of
the criminal investigation to the care home manager and owner in terms of
both the progress of the investigation and the likely timescales for completion
Imposing a temporary ban on all admissions to a home, pending the outcome
of the investigation, should only occur after a full risk assessment has
identified that it is the only way in which such protection can be achieved
successfully i.e. it has to be a proportionate and appropriate response to the
type and circumstances of the allegations.
KEY POINTS:
ANY OTHER SUGGESTIONS?
[email protected]
The Care Quality
Commission
The Care Quality Commission
Interview in the January 2011 Guardian:
Care providers will be asking themselves, what can I do to cut corners? The
sector is ready to slash costs as a result of public sector cuts. It is against this
background that the Commission is signalling that it will take an increasingly
tough line to ensure that essential standards are met – even when budgets
are cut.
To counter the threat CQC will use an organisation that does a lot of work for
the security services to scan what’s out there – either in newspapers or on the
net – and identify risk.
BBC December 2010
The CQC claim that 93 care homes and agencies had been shut in the past
year due to poor ratings was not true.
The Burstow Care Home, Sutton
Residents moved around in public scantily clad.
Very personal care, such as removing dentures, undertaken in public.
A resident was sat on a commode, in full view of other residents
Call bells were not accessible
Residents had to manage their own allergies
Residents had to wipe their soiled hands on bedclothes or clothing
Residents who needed help to eat and drink were left unaided
Food and fluid charts not completed, or not accurately completed. Food
intake record falsified in front of inspector
Paget University Hospital, Great Yarmouth
Inspected on 2 April 2011
Given 28 days to produce an action plan
Re-visited five months later – still failing.
Given another month to improve – or serious action will be taken
There was no Adult Safeguarding referral. There was no 'blanket ban' on
admissions. The requirements of the Mental Capacity Act 2005 (MCA) were
not applied. There was no immediate protection plan
Not Compliant
Whiston Hospital (St Helens and Knowsley Teaching Hospitals NHS Trust)
When we looked through records for people admitted from a care home we
were unable to locate the transfer information from the care home. Staff
confirmed that they usually received this but the information in them was not
always easily transferred to the hospital's own records.
Red trays and jugs are used to identify people who may need extra support
with food and drink. On another ward only two red trays were used despite
staff reporting and the CQC team observing that almost half the people
needed some form of assistance.
Compliant
Northwick Park Hospital (North West London Hospitals NHS Trust)
One elderly patient on Evelyn Ward, who was suffering from dementia, went
without food and oral fluids from midnight on three consecutive days until his
operation was cancelled each day.
On the day of our visit he was provided with a cup of tea when the nurse
became aware the operation had been cancelled at three o’clock. The patient
had been nil by mouth for fifteen hours until then although he had received
intravenous fluids. This put the patient at risk of inadequate nutrition as well
as unnecessary discomfort.
Compliant
Royal Devon and Exeter NHS FoundationTrust at Wonford,
‘We asked if patients had DNAR orders. Staff confirmed that some patients
did. We asked them to give an example of someone on the ward that had a
DNAR order and how and when this decision was reached. They gave the
example of a patient with a DNAR order whose decision for this was made
due to being 'elderly and with co-morbidities that make resuscitation less
appropriate'. We asked for more detail about being elderly and co-morbidities.
We were told that the DNAR order had been made on admission. A doctor
said that the main factor would be the patient's medical status. The doctor
was not aware if the patient or their advocate/ relatives had been involved in
the decision making for the DNAR, or how the views of a patient with
dementia are sought beyond taking to the nursing staff to find out what
information they have. The doctor said that if the team are aware of advance
directives that this is taking into account, however none of the care records
we looked at had this part completed.’
Not Compliant
Alexandra Hospital (Worcestershire Acute Hospitals NHS Trust).
One person was assessed as being ‘malnourished ‘on admission and there
were no details of their weight at that time. They were not reassessed until 16
days later. The records for another person showed they were seen by a
dietitian on admission and the following day and on each occasion a request
had been made to weigh the person. Notes 17 days later referred to the fact
that the person had not been weighed since admission.
We looked at records of fluid intake and output for some people and saw that
some people had received no fluids for long periods of time. In some cases
this exceeded 10 hours.
Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of all
health and adult social care in England.
Whether care services are provided by the NHS, local authorities or voluntary
organisations, CQC say that they make sure that people get better care. They
say they do this by:
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encouraging improvement across health and adult social care
putting people first and standing up for their rights
acting quickly to remedy bad practice
gathering and using knowledge and expertise, and working with others.
Elder Abuse Helpline
080 8808 8141
Admin telephone:
020 8835 9280
WEBSITE:
WWW.ELDERABUSE.ORG.UK
[email protected]